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Habib M. Razavi
Phone: (604) 520-4253 EXT 524875
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Address: Royal Columbian Hospital 330 E Columbia St, New Westminster,
British Columbia, Canada V3L 3W7
Email: habib.moshrefrazavi@fraserhealth.ca
Running title: LGL leukemia with paucity of erythropoiesis
Keywords: LGL leukemia, neutropenia, pure red cell aplasia
Abstract word count: 49
Word count (including figure labels): 199
Number of figures: 1
Number of tables: 0
Key clinical message.
The differential diagnosis for neutropenia is large and includes, drug
effect, viral infections, sepsis, immune, hypersplenism, bone marrow
disorder etc. The presence of an autoimmune disorder and lymphocytosis
should prompt the practitioner for a bone marrow biopsy to rule out a
lymphoproliferative disorder including large granular lymphocytic (LGL)
leukemia.
Accompanying text.
A 63 year old male patient with progressive lymphocytosis and cytopenias
is described. At presentation, he complained of an upper respiratory
tract infection and infrequent oral ulcers. His CBC showed a hemoglobin
at 106 g/L, neutrophils at 0.9 x 10E9/L and lymphocytes at 16.2 x10E9/L.
The peripheral blood film showed lymphocytosis with LGL morphology
(panel A, x 20). A bone marrow aspirate showed trilinear hematopoiesis
with paucity of erythropoiesis. As well, a lymphoid infiltrate was
present showing LGLs (panel B x 50). Biopsy showed a hypercellular bone
marrow with left shifted myelopoiesis, megakarycytopoiesis and scant
erythropoiesis (panels C x10, and panel D x40 respectively). CD20 and
CD34 staining for B lymphocytes and blasts are noncontributory (panel E
and F, x10). CD 3 showed interstitial and intersinudiodal (black arrow)
infiltration of T cells (panel G, x10 and panel F, x40). Multiplex PCR
analysis showed a clonal rearrangement in the TCR beta gene. Similar to
peripheral blood, flow cytometry on the aspirate returned an atypical
CD8+ T-cell population. The diagnosis of LGL leukemia with pure red cell
aplasia was made. The differential diagnosis of neutropenia is large. In
presence of an autoimmune disorder and lymphocytosis, LGL leukemia
should be ruled out1.
Reference.
Gazitt T and Loughran TP. Chronic Neutropenia in LGL Leukemia and
Rheumatoid Arthritis. Hematology Am Soc Hematol Educ
Program . 2017; 2017(1): 181-186.